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Eur Neuropsychopharmacol. 2017 Aug;27(8):795-808. doi: 10.1016/j.euroneuro.2017.05.005. Epub 2017 May 30.

Cannabinoids in attention-deficit/hyperactivity disorder: A randomised-controlled trial.

Author information

1
King׳s College London, MRC Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, UK; Newham Centre for Mental Health, Unit for Social and Community Psychiatry, Queen Mary University of London, UK. Electronic address: Ruth.Cooper1@elft.nhs.uk.
2
King׳s College London, MRC Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, UK.
3
King׳s College London, MRC Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, UK; Department of Medical and Molecular Genetics, Guy׳s Hospital, Great Maze Pond, 8th Floor Tower Wing, London SE1 9RT, UK.
4
King׳s College London, MRC Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, UK. Electronic address: philip.asherson@kcl.ac.uk.

Abstract

Adults with ADHD describe self-medicating with cannabis, with some reporting a preference for cannabis over ADHD medications. A small number of psychiatrists in the US prescribe cannabis medication for ADHD, despite there being no evidence from randomised controlled studies. The EMA-C trial (Experimental Medicine in ADHD-Cannabinoids) was a pilot randomised placebo-controlled experimental study of a cannabinoid medication, Sativex Oromucosal Spray, in 30 adults with ADHD. The primary outcome was cognitive performance and activity level using the QbTest. Secondary outcomes included ADHD and emotional lability (EL) symptoms. From 17.07.14 to 18.06.15, 30 participants were randomly assigned to the active (n=15) or placebo (n=15) group. For the primary outcome, no significant difference was found in the ITT analysis although the overall pattern of scores was such that the active group usually had scores that were better than the placebo group (Est=-0.17, 95%CI-0.40 to 0.07, p=0.16, n=15/11 active/placebo). For secondary outcomes Sativex was associated with a nominally significant improvement in hyperactivity/impulsivity (p=0.03) and a cognitive measure of inhibition (p=0.05), and a trend towards improvement for inattention (p=0.10) and EL (p=0.11). Per-protocol effects were higher. Results did not meet significance following adjustment for multiple testing. One serious (muscular seizures/spasms) and three mild adverse events occurred in the active group and one serious (cardiovascular problems) adverse event in the placebo group. Adults with ADHD may represent a subgroup of individuals who experience a reduction of symptoms and no cognitive impairments following cannabinoid use. While not definitive, this study provides preliminary evidence supporting the self-medication theory of cannabis use in ADHD and the need for further studies of the endocannabinoid system in ADHD.

KEYWORDS:

Attention deficit-hyperactivity disorder; Cannabinoids; Randomised-controlled trial; Self-medication

PMID:
28576350
DOI:
10.1016/j.euroneuro.2017.05.005
[Indexed for MEDLINE]

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